Ineligible Patients Enrolled in Medicaid Program by Agency in NY

The New York Medicaid system is the largest in the nation. As most know, Medicaid is a joint federal-state program, paid for by both entities. While federal parameters must be met, each state is free to decide upon various details of the program, including eligibility and extensiveness of support provided. New York has elected to open Medicaid to many residents with comparatively generous support.

Of course, the more expansive system comes with a high price tag. In order to ensure every dollar spent on the program is used efficiently, the state has engaged in a recent push to crack down on Medicaid fraud.

NY Visiting Nurse Service Problem
One manifestation of that fraud is when service providers enroll individuals who do not actually qualify for services. In fact, last week the New York Timesreported on a New York long-term care agency that will be required to repay millions to state coffers for allegedly doing just that.

The report explains how Visiting Nurse Service of New York Choice (VNSNY Choice) improperly billed Medicaid for social adult day care center services. The NY Attorney General announced Friday that the company will repay $33.6 million to settle the matter.

The potential abuse of the adult social service programs first came to public attention several months ago when many of the supposedly frail “seniors” at the facility were seen performing activities that they would not have been able to perform is they were truly frail, including bicycling and playing vigorous games.

Programs like VNSNY Choice are paid a set sum of money each month per individual enrolled in Medicaid ($3,800). From that pool of money, the company pays for various long-term services, including home health care, aides, and adult social daycare. Yet this system creates incentives for individual care providers to push for more enrollment, regardless of an individual’s actual need for services. In fact, the article explains that “some centers offered incentives like cash gifts and casino trips, drawing elderly people who did not seem to need long-term care.”

Trusted Advice
As this case demonstrates, it is important to receive advice regarding New York Medicaid enrollment only from reputable sources. Our team of elder law attorneys has offices throughout the state and is proud to work with families on these and similar long-term care planning measures. Feel free to reach out to us today to see how we can help.